Provider Demographics
NPI:1740835990
Name:KEATHLEY, TRACEY (RN)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:KEATHLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LAKEWOOD LDG
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2230
Mailing Address - Country:US
Mailing Address - Phone:865-617-5039
Mailing Address - Fax:865-315-7232
Practice Address - Street 1:114 LAKEWOOD LDG
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2230
Practice Address - Country:US
Practice Address - Phone:865-617-5039
Practice Address - Fax:865-315-7232
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000120176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse